Summary: Studies have
found that patients with complex and life-threatening health conditions
are more likely to seek out complementary and integrative services.
This article focuses on two companies, Florida-based Yellow Courtyard
and Colorado-based Lynxcare which were established by integrated care users to support people in these times of
need with integrative, medical-records-based solutions. Both claim
health value; one is increasingly focusing its business model on anticipated cost
savings. Their target markets range from high-income seniors to groups and payer
organizations, such as Medicaid ...

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Sharon Feder, President, Lynxcare

Jason Gordon and Sharon Feder don't know each other.
But they have some of pieces of personal history in common. Both
struggled over a period of years with complex healthcare problems.
Gordon worked for years with his own cancer, now in remission. Feder managed
a series of complex conditions faced by one of her sons. Each used the
services of numerous conventional and complementary healthcare
practitioners and therapies.

These histories do not distinguish them, particularly. Faced
with challenging, life-threatening and chronic problems, growing numbers of healthcare consumers seek direction and support from whatever sources they can find.

One business focuses on individual contracts. The other increasingly sees thefuture of its business as providing cost-saving forpurchasers for groups,such as Medicaid.

What distinguishes Gordon and Feder is that these two each emerged from
their healthcare trials with a business plan to help others in similar situations. In 2004, Feder founded Colorado-based Lynxcare Collaborative Network. Gordon launched Miami-based Yellow Courtyard just four months ago, in May of 2007. Their businesses
each fall into the broad categories of patient advocacy. Each features a medical records component.

Yet their business models, and the roles
that integrative or holistic medicine and complementary healthcare play
in their models, vary significantly. Lynxcare Collaborative Network sees its future as gaining contracts from Medicaid and other organizations. Yellow Courtyard focuses on individual contracts. Here is a look at the two models.
1. Yellow Courtyard: Promoting "inclusionary health"A recent issue of Natural Solutions magazine featured a
back cover advertisement that read: "Imagine Thousands of Years of
Medical Wisdom Together in One Place. Welcome to Yellow Courtyard. Step
inside and discover." The fine print claims that a person who enters
will not only "find all the resources to take charge of your total
health" but that these resources include "state-of-the-art technology
for easy access to your medical records."
Founder Jason Gordon is featured inside in a full-page ad with a photo of him next to a set of questions and answers. These direct you to the Yellow Courtyard website.
The inviting homepage, like the full-page ads, declares that the
operation has significant ambition.
Yellow Courtyard announces a
new catch-phrase for care integration: "inclusionary health."

Jason Gordon, Yellow Courtyard founder

A "Practitioner" button opens to
a map of the full United States. One dot marks the location of Yellow
Courtyard's first network, in Miami. The site promises that other geographically-based operations will be
created. Down the homepage are a handful of
trademarked products for providing and managing information. There is
even a Yellow Courtyard University. A FAQ button does a good job answering core questions.

But who are these people? What capital is backing them? I contacted Gordon through his Miami-based media firm.

The Practitioner Infrastructure for the Patient's ExperienceYellow Courtyard's origin story is Gordon's experimentation with various therapies in his care process. Gordon, a
shiatsu therapist prior to the onset of his cancer,
also undertook to deepen his own education as a provider. His education culminated in a
degree from an acupuncture and Oriental medicine
school and gaining licensure in Florida as an "acupuncture physician."
Florida is the one state that grants licensed acupuncturists the right
to use that appellation.

Through the group of practitioners Gordon encountered, he developed his first "Yellow Courtyard
Network." The network ranges from medical doctors to
mind-body and Yoga practitioners. For patients who purchase the services, Yellow Courtyard promises that over "200
modalities" will be considered.

At
the center of the care, and helping the patient manage a path through
the scores of options is a "Primary Educational Provider"
(PEP). The PEP, says Gordon, is a physician - a
medical doctor, osteopath or an acupuncture physician. The PEP helps
the patient manage a relationship with what Gordon calls a "dream team." Says Gordon: "This is an A-list of practitioners who have gone through our screening." The screening, says Gordon, includes typical credentialing - education, certification, licensing where appropriate. They also seek to insure that the practitioner is "open-minded, able to be collaborative, and speaks multiple medical languages." Gordon acknowledges certain "subjectivity." He also acknowledges the need to clear up a present hole in the credentialing process.

Program
level

Price

#
Subscribers

Bronze

Free

--

Silver

$14.95/
month

45

Gold

$1495/
year

18

Platinum

$6250/
year

1

The Patient Experience

Yellow Courtyard consider a consumer of their services an "Explorer."
Explorers can participate at one of four levels: Bronze, Silver, Gold
and Platinum. The entry level, Bronze, is free. A person has access to
information (a journal, From All
Angles TM,and a Manual of Medical Perspectives TM). They also receive
and discounts on products at the Courtyard Market. Yellow
Courtyard makes much of its process for vetting products which it sells.
Silver members pay $14.95/month. The most significant additional
values are that these Explorers have access to a secure, online medical record storage and an online
personal health journal.
The consumer's direct relationship with Yellow
Courtyard practitioners begins with the Gold level, at a robust
$1,495/year. Here the consumer is assigned a Primary Education Provider (PEP). The
PEP facilitates a consultation with a multi-disciplinary,
five-member clinical team. The team includes specialists in Western
medicine,
Oriental medicine, nutrition, psychology and energy medicine. The Gold-level
member also has a 30-60 minute individual session with each. No
clinical
services are offered at this time. Each makes a report to the PEP. The
PEP then develops an "Integrative Diagnosis and Treatment Strategy" and
meets with the patient with recommendations for care. Referrals are made to members of the broader practitioner network. The member is responsible for paying separately for the cost of treatments.
At
the Platinum level ($6250/yr) the subscriber has continuous contact with
the PEP throughout the year. The person also has a consultation with the "dream team" every 10
weeks. Full benefits at each level are provided here.

Business Experience and Next Steps

Gordon expresses comfort in the status of the program in its first
months. "We've had quite a few sign up," he says. Current totals are included in the chart.

Gordon says that the business start-up has been "all self-funded until now." He says that the firm is "weeks away from taking on investors." No precise information was provided about the size of investment he is seeking or the first markets into which the firm plans to expand.
I

Concierge Education

Yellow Courtyard sees some overlap with the concierge medicine movement, then adds that what the firm offersis "concierge education."

asked Gordon how he viewed Yellow Courtyard in the context of the "concierge medicine" movement in conventional medicine in which individuals pay a monthly or annual fee for a special level of care, outside the 3rd party payment system. Gordon says there are "overlapping
principles." Among these are that there is a fee paid, the subscriber gets focused healthcare attention and have "access to
answers." But Gordon clarifies that the fee that is paid to Yellow Courtyard is only for
the education, coordination and record management functions. Each subscriber pays separately for any services.
Adds Gordon: "It's concierge education."

Yellow Courtyard's Miami base, with its high population of well-to-do seniors with complex conditions might be an exceptionally appropriate birthplace for this model.
2. Lynx Collaborative Care Network

Victoroff brings a diverse background to his
work as executive vice president and chief medical officer for the firm
which he co-founded. He has developed practice management software, served as a managed care executive, completed a residency in
biomedical ethics, practiced 20 years of family medicine and obstetrics and was named physician of the year by the Colorado Academy of Family Physicians. But it is Victoroff's experience in forensic medicine from 2002-2006, as an investigator
for the University of Colorado Department of Toxicology on
cases of suspected environmental chemical exposures, that most shapes his view of Lynxcare. Says Victoroff: "We do kind of what a detective would do."

The elements in which the detective work come into play are many. First, Lynxcare develops and provides a "medical records summary." Feder explains that "if a person needs a consultation with a top neurologist, (the neurologist) won't go through 700 pages of a medical record." In developing the summary, Lynxcare will often unearth forgotten or over-looked aspects of the case. The basic fee for the summary service is typically $500, with annual updates at $64.

"Alternative approaches fill a lot of the gaps in the system."

- Michael Victoroff, MD,co-founder

Lynxcare also engages the sleuthing to find experts who may be helpful with a diagnosis or treatment. Says Feder: "With the summary, we can get opinions from top people quickly." Karlo Berger, ABT, LMT, who is listed as an Alternative Medicine Researcher on the Lynxcare site offers an example. Recalls Berger, the founder of theIntegrative Medicine Alliance: "The last time (Lynxcare)
contacted me was to find the right CAM practitioners for a newborn
with severe neurological problems. In the end I found a pair of sisters
who were trained as medical doctors in China and have an acupuncture
practice with a neurological focus. They were willing to travel to the
baby's home to deliver the care."

Lynxcare's other detective and advocacy services include analysis of drug interactions, preparing patients for their clinical visits by providing a list of key questions, representing patients in communications with their specialists, and helping with appeals on coverage. Hourly fees run from $40 to $350, depending on the service required. The site lists the fee schedule.The Role of Complementary Care Services at Lynxcare

On its homepage, Lynxcare specifically notes its complementary care in describing its research offering: Find the best available evidence and treatment options
in mainstream medicine, as well as complementary and alternative
medicine. Besides Berger, the Lynxcare team includes two medical doctors with significant integrative experience. Brian Bouch, MD, was a medical director with the Onebody.com (formerly Consensus Health) ill-fated dot.com venture. Others include an acupuncturist, Connie Sanchez, ND, holistic medical doctor Jerry Rubin, MD, and Sol Grazi, MD, a former board member of theAmerican Holistic Medical Association.

Michael Victoroff, MD, Co-Founder, Lynxcare

I asked Victoroff about the high visibility of these non-conventional services. He says that part of the reason is Feder's interest, and that many of their key conventional consultants are not on the site. Then he adds: "Alternative approaches fill a lot of the gaps in the system. We don't see alternative medicine as a rejection. We believe in an integrated approach. We want to be clear that we have options for people who have reached the end of what contemporary science could offer them." Victoroff estimates that "just under half" of their clients have asked for help with complementary medicine services. He guesses that "this is much more than a typical health advocate (business) population."
Business Model and Expectations for Success

To date, the business has served about 100 paying clients. Both Feder and Victoroff quickly note that they have actually serve "probably another 100 people per year" with some informal consulting but short of contracting. The investment is not yet paying for itself. Says Feder: "Michael and I have made a big time investment in this." She adds: "Michael's been doing all the marketing and development for free."

Lynxcare is negotiating
for contracts with groups,arguing that their services
lower costs and increase
efficiency and quality of life.

Both Feder and Victoroff believe that the business is about to turn the corner. Interestingly, it will not likely be from individuals suddenly discovering the services and seeking some form of what Yellow Courtyard's Gordon calls "concierge education." Rather, Lynxcare is negotiating with some consumer groups for contracts, arguing that the program lowers costs and increases efficiency and quality of life.

One such organization represents individuals with severe disabilities. Victoroff believes this will likely be the first to sign. Victoroff has also opened a conversation with the leadership of Colorado Medicaid. While he says they found receptivity at the senior levels, he expects any contract will take a year or two. Feder says that payment could likely come through a "self-directed" Medicaid fund which states are now allowed.

Feder acknowledges that the start-up has taken longer than expected. Yet she is undaunted, stating simply: "It's a difficult pitch to sell a new concept."

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